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No signal for the superiority of autologous versus allogenic stem-cell transplants in T-cell lymphoma
A randomized trial designed to compare autologous to allogeneic stem cell transplantation as first-line therapy in younger patients with peripheral T-cell lymphoma was discontinued early because nearly 40% of the patients had early disease progression and did not undergo transplantation.
Peripheral T-cell lymphoma generally yields a poor prognosis when treated with conventional chemotherapy, but autologous or allogeneic stem cell transplants were thought to be an option for patients with relapsing or refractory disease. Based on this hypothesis, the AATT (Autologous or Allogeneic Transplantation in T-Cell Lymphoma) study explored stem cell transplant as a first-line therapy, enrolling 104 patients aged 18-60 between 2011 and 2014.
All patients received four courses of chemotherapy with CHOEP-14 (cyclophosphamide, adriamycin, vincristine, etoposide, and prednisone).
Those in the autologous stem cell group and those without a suitable donor proceeded to one course of DHAP (high-dose ara-C, cis-platinum, and dexamethasone) and stem cell collection. Patients randomized to autologous transplantation received high dose therapy (BCNU, etoposide, cytarabine, melphalan: BEAM) followed 4-6 weeks later by transplantation of autologous stem cells.
Patients randomized to allogeneic transplantation received high dose therapy (fludarabine, busulfan, cyclophosphamide: FBC) followed by transplantation of allogeneic stem cells. GvHD prophylaxis included antithymocyte globuline (ATG), cyclosporine A, and mycophenolate mofetil.
Among the 58 patients eligible for the interim analysis, the mean age was 50 and 64% were male. Thirteen of the 28 patients randomized for allogeneic transplants underwent transplants; the others were not allografted because of progressive disease or lack of a donor. Of the 30 patients randomized to autologous SCT, 19 had the procedure; 11 did not receive transplants because of progressive disease or infection, Dr. Norbert Schmitz of Asklepios Klinik St. Georg, Hamburg, Germany, reported at the International Congress on Malignant Lymphoma in Lugano, Switzerland.
The primary outcome, 1-year event-free survival (EFS), was 41% in the intent-to-treat population (95% CI, 27%–54%).
Causes of death included lymphoma (seven autologous, five allogeneic), salvage therapy (two), early or late infections (four), and graft vs. host disease (two).
Survival rates did not significantly differ in the two stem cell transplant groups, but the findings lend themselves to limited interpretation as more than 30% of patients did not receive the procedure. Based on the low probability of meeting the primary outcome, the data safety monitoring board decided to stop patient accrual and discontinue the trial.
*This article was updated 7/8/2015.
As outcomes for patients with PTCL are suboptimal with standard therapy, usually CHOP/CHOEP, young and fit patients are commonly offered high dose chemotherapy with stem cell support (SCT) to consolidate 1st remission, though no firm data support this approach. As a trial of SCT vs observation would be difficult to accomplish, the AATT trail was undertaken to compare autologous vs allogeneic transplantation. The trial was not able to answer this question as it was halted early due to the high proportion of patients unable to proceed to SCT. One lesson here is that data reported for PTCL patients who receive SCT in 1st remission suffers from selection bias, unless accompanied by an intent-to-treat analysis. There is a clear need for improved induction therapy for PTCL.
As outcomes for patients with PTCL are suboptimal with standard therapy, usually CHOP/CHOEP, young and fit patients are commonly offered high dose chemotherapy with stem cell support (SCT) to consolidate 1st remission, though no firm data support this approach. As a trial of SCT vs observation would be difficult to accomplish, the AATT trail was undertaken to compare autologous vs allogeneic transplantation. The trial was not able to answer this question as it was halted early due to the high proportion of patients unable to proceed to SCT. One lesson here is that data reported for PTCL patients who receive SCT in 1st remission suffers from selection bias, unless accompanied by an intent-to-treat analysis. There is a clear need for improved induction therapy for PTCL.
As outcomes for patients with PTCL are suboptimal with standard therapy, usually CHOP/CHOEP, young and fit patients are commonly offered high dose chemotherapy with stem cell support (SCT) to consolidate 1st remission, though no firm data support this approach. As a trial of SCT vs observation would be difficult to accomplish, the AATT trail was undertaken to compare autologous vs allogeneic transplantation. The trial was not able to answer this question as it was halted early due to the high proportion of patients unable to proceed to SCT. One lesson here is that data reported for PTCL patients who receive SCT in 1st remission suffers from selection bias, unless accompanied by an intent-to-treat analysis. There is a clear need for improved induction therapy for PTCL.
A randomized trial designed to compare autologous to allogeneic stem cell transplantation as first-line therapy in younger patients with peripheral T-cell lymphoma was discontinued early because nearly 40% of the patients had early disease progression and did not undergo transplantation.
Peripheral T-cell lymphoma generally yields a poor prognosis when treated with conventional chemotherapy, but autologous or allogeneic stem cell transplants were thought to be an option for patients with relapsing or refractory disease. Based on this hypothesis, the AATT (Autologous or Allogeneic Transplantation in T-Cell Lymphoma) study explored stem cell transplant as a first-line therapy, enrolling 104 patients aged 18-60 between 2011 and 2014.
All patients received four courses of chemotherapy with CHOEP-14 (cyclophosphamide, adriamycin, vincristine, etoposide, and prednisone).
Those in the autologous stem cell group and those without a suitable donor proceeded to one course of DHAP (high-dose ara-C, cis-platinum, and dexamethasone) and stem cell collection. Patients randomized to autologous transplantation received high dose therapy (BCNU, etoposide, cytarabine, melphalan: BEAM) followed 4-6 weeks later by transplantation of autologous stem cells.
Patients randomized to allogeneic transplantation received high dose therapy (fludarabine, busulfan, cyclophosphamide: FBC) followed by transplantation of allogeneic stem cells. GvHD prophylaxis included antithymocyte globuline (ATG), cyclosporine A, and mycophenolate mofetil.
Among the 58 patients eligible for the interim analysis, the mean age was 50 and 64% were male. Thirteen of the 28 patients randomized for allogeneic transplants underwent transplants; the others were not allografted because of progressive disease or lack of a donor. Of the 30 patients randomized to autologous SCT, 19 had the procedure; 11 did not receive transplants because of progressive disease or infection, Dr. Norbert Schmitz of Asklepios Klinik St. Georg, Hamburg, Germany, reported at the International Congress on Malignant Lymphoma in Lugano, Switzerland.
The primary outcome, 1-year event-free survival (EFS), was 41% in the intent-to-treat population (95% CI, 27%–54%).
Causes of death included lymphoma (seven autologous, five allogeneic), salvage therapy (two), early or late infections (four), and graft vs. host disease (two).
Survival rates did not significantly differ in the two stem cell transplant groups, but the findings lend themselves to limited interpretation as more than 30% of patients did not receive the procedure. Based on the low probability of meeting the primary outcome, the data safety monitoring board decided to stop patient accrual and discontinue the trial.
*This article was updated 7/8/2015.
A randomized trial designed to compare autologous to allogeneic stem cell transplantation as first-line therapy in younger patients with peripheral T-cell lymphoma was discontinued early because nearly 40% of the patients had early disease progression and did not undergo transplantation.
Peripheral T-cell lymphoma generally yields a poor prognosis when treated with conventional chemotherapy, but autologous or allogeneic stem cell transplants were thought to be an option for patients with relapsing or refractory disease. Based on this hypothesis, the AATT (Autologous or Allogeneic Transplantation in T-Cell Lymphoma) study explored stem cell transplant as a first-line therapy, enrolling 104 patients aged 18-60 between 2011 and 2014.
All patients received four courses of chemotherapy with CHOEP-14 (cyclophosphamide, adriamycin, vincristine, etoposide, and prednisone).
Those in the autologous stem cell group and those without a suitable donor proceeded to one course of DHAP (high-dose ara-C, cis-platinum, and dexamethasone) and stem cell collection. Patients randomized to autologous transplantation received high dose therapy (BCNU, etoposide, cytarabine, melphalan: BEAM) followed 4-6 weeks later by transplantation of autologous stem cells.
Patients randomized to allogeneic transplantation received high dose therapy (fludarabine, busulfan, cyclophosphamide: FBC) followed by transplantation of allogeneic stem cells. GvHD prophylaxis included antithymocyte globuline (ATG), cyclosporine A, and mycophenolate mofetil.
Among the 58 patients eligible for the interim analysis, the mean age was 50 and 64% were male. Thirteen of the 28 patients randomized for allogeneic transplants underwent transplants; the others were not allografted because of progressive disease or lack of a donor. Of the 30 patients randomized to autologous SCT, 19 had the procedure; 11 did not receive transplants because of progressive disease or infection, Dr. Norbert Schmitz of Asklepios Klinik St. Georg, Hamburg, Germany, reported at the International Congress on Malignant Lymphoma in Lugano, Switzerland.
The primary outcome, 1-year event-free survival (EFS), was 41% in the intent-to-treat population (95% CI, 27%–54%).
Causes of death included lymphoma (seven autologous, five allogeneic), salvage therapy (two), early or late infections (four), and graft vs. host disease (two).
Survival rates did not significantly differ in the two stem cell transplant groups, but the findings lend themselves to limited interpretation as more than 30% of patients did not receive the procedure. Based on the low probability of meeting the primary outcome, the data safety monitoring board decided to stop patient accrual and discontinue the trial.
*This article was updated 7/8/2015.
FROM 13-ICML
Key clinical point: Survival rates did not significantly differ for autologous versus allogenic stem cell transplant in patients with peripheral T-cell lymphoma, but the findings lend themselves to limited interpretation as more than 30% of patients did not receive the procedures.
Major finding: Early disease progression led to the discontinuation of a randomized trial comparing autologous to allogeneic stem cell transplantation in younger patients with peripheral T-cell lymphoma.
Data source: Results from 58 patients eligible for the interim analysis.
Disclosures: There were no relevant financial disclosures.
Bendamustine regimen may be induction-therapy option in mantle cell lymphoma
Rituximab plus bendamustine may prove to be an induction-therapy option for younger patients with mantle cell lymphoma, Dr. Richard Chen and his colleagues in a SWOG (Southwest Oncology Group) trial reported at the International Congress on Malignant Lymphoma in Lugano, Switzerland.
Compared with a more aggressive combination regimen, a rituximab plus bendamustine (Treanda) option is a simple regimen that can be given in an outpatient setting and was associated with fewer adverse events and similar 2-year outcomes, the researchers found. The more aggressive regimen, however, was associated with lower-than-expected stem cell mobilization rates and the trial was prematurely closed, allowing no significant results.
For this study, two induction-therapy regimens were compared in 53 patients with untreated stage III or IV (or bulky stage II) mantle cell lymphoma. All patients were less than age 65 years and received rituximab (R) in combination with one of two regimens: 18 patients received four cycles of R-HyperCVAD + methotrexate + cytarabine (R-HyperCVAD/MTX/ARA-C) and 35 patients received six cycles of R-bendamustine.
The overall response rate was 94% with R-HyperCVAD/MTX/ARA-C and 86% with R-bendamustine; the complete response rates were 31% and 43%, respectively; the partial response rates were 62% and 43%, respectively, Dr. Chen and his associates reported.
The median follow-up for surviving patients is nearly 24 months. The estimated 2-year progression-free survival was 87% for patients in both treatment groups.
Significantly higher rates of bone marrow toxicity occurred in the group receiving the R-HyperCVAD/MTX/ARA-C regimen, compared with the bendamustine regimen. Grade 3 and 4 thrombocytopenia occurred in 69% given R-HyperCVAD/MTX/ARA-C and 17% given R-bendamustine. Anemia affected 56% of those given R-HyperCVAD/MTX/ARA-C and 8.6% given R-bendamustine. Neutropenia was seen in 63% given R-HyperCVAD/MTX/ARA-C and 34% of patients given R-bendamustine. Febrile neutropenia occurred in 31% given R-HyperCVAD/MTX/ARA-C and 14% given R-bendamustine.
The study was discontinued prematurely because of the low mobilization of stem cells at the transplant phase of the study in patients given R-HyperCVAD/MTX/ARA-C. Just 4 of 16 patients on R-HyperCVAD/MTX/ARA-C and 21 of 35 patients given R-bendamustine underwent autologous stem cell transplants.
The R-bendamustine regimen seems less myelosuppressive. Because of the premature closure of the trial, the study did not reach statistical significance for 2-year progression-free survival, the researchers reported. Since bendamustine in combination with rituximab was associated with lower rates of hematologic toxicity, however, it warrants further study as an induction regimen, they concluded.
Young, fit patients with mantle cell lymphoma (MCL) are often treated with intensive, though non-curative, therapy. While some centers still use R-HyperCVAD/MA alone, most use alternating R-CHOP-based and high dose cytarabine-based regimens, followed by SCT. The U.S. Intergroup trial, led by SWOG, was designed to gather information about a strategy using a limited number of cycles of R-HyperCVAD/MA followed by SCT, and an alternative strategy using an effective but less-intense induction, bendamustine-rituximab (BR), also followed by SCT. The R-HyperCVAD/MA arm was closed early due to difficulties with stem cell collection. While there are technical reasons for this that likely could be overcome, results with other pre-SCT regimens are good enough that this is not likely to be further studied. The BR followed by SCT arm was closed after accrual of 35 patients, enough to get a sense that this was feasible, although it will be important to see further updates regarding how many of these patients did go on to SCT, and their ultimate outcomes. A key question is whether a study comparing BR induction with a different, commonly used intense regimen pre-SCT is worth the commitment of resources, given the range of novel agents now available for MCL.
Dr. Mitchell Smith is a medical oncologist affiliated with the Cleveland Clinic.
Young, fit patients with mantle cell lymphoma (MCL) are often treated with intensive, though non-curative, therapy. While some centers still use R-HyperCVAD/MA alone, most use alternating R-CHOP-based and high dose cytarabine-based regimens, followed by SCT. The U.S. Intergroup trial, led by SWOG, was designed to gather information about a strategy using a limited number of cycles of R-HyperCVAD/MA followed by SCT, and an alternative strategy using an effective but less-intense induction, bendamustine-rituximab (BR), also followed by SCT. The R-HyperCVAD/MA arm was closed early due to difficulties with stem cell collection. While there are technical reasons for this that likely could be overcome, results with other pre-SCT regimens are good enough that this is not likely to be further studied. The BR followed by SCT arm was closed after accrual of 35 patients, enough to get a sense that this was feasible, although it will be important to see further updates regarding how many of these patients did go on to SCT, and their ultimate outcomes. A key question is whether a study comparing BR induction with a different, commonly used intense regimen pre-SCT is worth the commitment of resources, given the range of novel agents now available for MCL.
Dr. Mitchell Smith is a medical oncologist affiliated with the Cleveland Clinic.
Young, fit patients with mantle cell lymphoma (MCL) are often treated with intensive, though non-curative, therapy. While some centers still use R-HyperCVAD/MA alone, most use alternating R-CHOP-based and high dose cytarabine-based regimens, followed by SCT. The U.S. Intergroup trial, led by SWOG, was designed to gather information about a strategy using a limited number of cycles of R-HyperCVAD/MA followed by SCT, and an alternative strategy using an effective but less-intense induction, bendamustine-rituximab (BR), also followed by SCT. The R-HyperCVAD/MA arm was closed early due to difficulties with stem cell collection. While there are technical reasons for this that likely could be overcome, results with other pre-SCT regimens are good enough that this is not likely to be further studied. The BR followed by SCT arm was closed after accrual of 35 patients, enough to get a sense that this was feasible, although it will be important to see further updates regarding how many of these patients did go on to SCT, and their ultimate outcomes. A key question is whether a study comparing BR induction with a different, commonly used intense regimen pre-SCT is worth the commitment of resources, given the range of novel agents now available for MCL.
Dr. Mitchell Smith is a medical oncologist affiliated with the Cleveland Clinic.
Rituximab plus bendamustine may prove to be an induction-therapy option for younger patients with mantle cell lymphoma, Dr. Richard Chen and his colleagues in a SWOG (Southwest Oncology Group) trial reported at the International Congress on Malignant Lymphoma in Lugano, Switzerland.
Compared with a more aggressive combination regimen, a rituximab plus bendamustine (Treanda) option is a simple regimen that can be given in an outpatient setting and was associated with fewer adverse events and similar 2-year outcomes, the researchers found. The more aggressive regimen, however, was associated with lower-than-expected stem cell mobilization rates and the trial was prematurely closed, allowing no significant results.
For this study, two induction-therapy regimens were compared in 53 patients with untreated stage III or IV (or bulky stage II) mantle cell lymphoma. All patients were less than age 65 years and received rituximab (R) in combination with one of two regimens: 18 patients received four cycles of R-HyperCVAD + methotrexate + cytarabine (R-HyperCVAD/MTX/ARA-C) and 35 patients received six cycles of R-bendamustine.
The overall response rate was 94% with R-HyperCVAD/MTX/ARA-C and 86% with R-bendamustine; the complete response rates were 31% and 43%, respectively; the partial response rates were 62% and 43%, respectively, Dr. Chen and his associates reported.
The median follow-up for surviving patients is nearly 24 months. The estimated 2-year progression-free survival was 87% for patients in both treatment groups.
Significantly higher rates of bone marrow toxicity occurred in the group receiving the R-HyperCVAD/MTX/ARA-C regimen, compared with the bendamustine regimen. Grade 3 and 4 thrombocytopenia occurred in 69% given R-HyperCVAD/MTX/ARA-C and 17% given R-bendamustine. Anemia affected 56% of those given R-HyperCVAD/MTX/ARA-C and 8.6% given R-bendamustine. Neutropenia was seen in 63% given R-HyperCVAD/MTX/ARA-C and 34% of patients given R-bendamustine. Febrile neutropenia occurred in 31% given R-HyperCVAD/MTX/ARA-C and 14% given R-bendamustine.
The study was discontinued prematurely because of the low mobilization of stem cells at the transplant phase of the study in patients given R-HyperCVAD/MTX/ARA-C. Just 4 of 16 patients on R-HyperCVAD/MTX/ARA-C and 21 of 35 patients given R-bendamustine underwent autologous stem cell transplants.
The R-bendamustine regimen seems less myelosuppressive. Because of the premature closure of the trial, the study did not reach statistical significance for 2-year progression-free survival, the researchers reported. Since bendamustine in combination with rituximab was associated with lower rates of hematologic toxicity, however, it warrants further study as an induction regimen, they concluded.
Rituximab plus bendamustine may prove to be an induction-therapy option for younger patients with mantle cell lymphoma, Dr. Richard Chen and his colleagues in a SWOG (Southwest Oncology Group) trial reported at the International Congress on Malignant Lymphoma in Lugano, Switzerland.
Compared with a more aggressive combination regimen, a rituximab plus bendamustine (Treanda) option is a simple regimen that can be given in an outpatient setting and was associated with fewer adverse events and similar 2-year outcomes, the researchers found. The more aggressive regimen, however, was associated with lower-than-expected stem cell mobilization rates and the trial was prematurely closed, allowing no significant results.
For this study, two induction-therapy regimens were compared in 53 patients with untreated stage III or IV (or bulky stage II) mantle cell lymphoma. All patients were less than age 65 years and received rituximab (R) in combination with one of two regimens: 18 patients received four cycles of R-HyperCVAD + methotrexate + cytarabine (R-HyperCVAD/MTX/ARA-C) and 35 patients received six cycles of R-bendamustine.
The overall response rate was 94% with R-HyperCVAD/MTX/ARA-C and 86% with R-bendamustine; the complete response rates were 31% and 43%, respectively; the partial response rates were 62% and 43%, respectively, Dr. Chen and his associates reported.
The median follow-up for surviving patients is nearly 24 months. The estimated 2-year progression-free survival was 87% for patients in both treatment groups.
Significantly higher rates of bone marrow toxicity occurred in the group receiving the R-HyperCVAD/MTX/ARA-C regimen, compared with the bendamustine regimen. Grade 3 and 4 thrombocytopenia occurred in 69% given R-HyperCVAD/MTX/ARA-C and 17% given R-bendamustine. Anemia affected 56% of those given R-HyperCVAD/MTX/ARA-C and 8.6% given R-bendamustine. Neutropenia was seen in 63% given R-HyperCVAD/MTX/ARA-C and 34% of patients given R-bendamustine. Febrile neutropenia occurred in 31% given R-HyperCVAD/MTX/ARA-C and 14% given R-bendamustine.
The study was discontinued prematurely because of the low mobilization of stem cells at the transplant phase of the study in patients given R-HyperCVAD/MTX/ARA-C. Just 4 of 16 patients on R-HyperCVAD/MTX/ARA-C and 21 of 35 patients given R-bendamustine underwent autologous stem cell transplants.
The R-bendamustine regimen seems less myelosuppressive. Because of the premature closure of the trial, the study did not reach statistical significance for 2-year progression-free survival, the researchers reported. Since bendamustine in combination with rituximab was associated with lower rates of hematologic toxicity, however, it warrants further study as an induction regimen, they concluded.
FROM 13-ICML
Key clinical point: Rituximab plus bendamustine may prove to be an option for induction therapy prior to autologous stem cell transplant in patients with mantle cell lymphoma.
Major finding: The overall response rate was 94% with R-HyperCVAD/MTX/ARA-C and 86% with R-bendamustine; the complete response rates were 31% and 43%, respectively; the partial response rates were 62% and 43%, respectively.
Data source: 53 patients with untreated stage III or IV (or bulky stage II) mantle cell lymphoma.
Disclosures: The investigators did not report any conflicts.
Second pathology review boosts diagnostic accuracy in lymphoma
In patients with newly diagnosed lymphoma and suspected lymphoma, a second pathological review found inaccuracies in the original diagnosis among 17% of more than 42,000 cases, based on data presented at the International Congress on Malignant Lymphoma in Lugano, Switzerland.
In more than 25% of all discrepancies, tumors were reclassified at the second pathology review as the result of findings from additional immunostaining and molecular studies – polymerase chain reaction and fluorescence in situ hybridization.
In 15% of cases, diagnostic changes were expected to result in a change in patient management.
“Our study highlights the importance of specialized centralized review of lymphoma diagnosis, not only in the setting of clinical trials but also in routine clinical practice, for optimal patient management,” reported Dr. Camille Laurent of the Institut Universitaire du Cancer Oncopole, Toulouse, France.
In 2010, the French National Cancer Agency (INCa) established the Lymphopath Network, comprising 33 reference centers, to provide a review by expert hematopathologists of every newly diagnosed lymphoma or suspected lymphoma prior to treatment. These new diagnoses were entered in a central national database. Between 2010 and 2015, 42,146 samples were reviewed: 35,753 were newly diagnosed as lymphomas, while the remaining 6,393 cases included 4,610 reactive lymphoid conditions and 1,783 nonlymphoid malignancies, including especially myeloma and leukemic disorders.
Discordant diagnoses among extra-cutaneous lymphomas were carefully examined by a hematologist and recorded as major or minor depending on the expected therapeutic impact. Dr. Laurent said.
The discordance rate between the referral diagnosis and the final diagnosis was 17.2%. Small B-cell lymphomas and peripheral T-cell lymphoma subtyping were the most common discrepancies; 6.4% of discordances were due to an unspecified lymphoma diagnosis, Dr. Laurent stated.
Less than 2% of discrepancies were due to misclassifications of benign versus malignant lymphoid conditions and of Hodgkin lymphoma versus non-Hodgkin lymphoma. There were minor discrepancies (2.2%) in follicular lymphoma misgrading and diffuse large B-cell lymphoma subtypes.
Given the complexity of lymphoma classification, it is not surprising that expert hematopathologists can refine diagnoses. As we progress in understanding the specific pathogenesis of lymphoma subtypes and utility of targeted therapy, it becomes even more critical to make correct diagnoses. This study reiterates the importance of expert review for many, if not all, lymphoma samples, particularly any T-cell lymphoma and non—follicular small B-cell lymphoma.
Given the complexity of lymphoma classification, it is not surprising that expert hematopathologists can refine diagnoses. As we progress in understanding the specific pathogenesis of lymphoma subtypes and utility of targeted therapy, it becomes even more critical to make correct diagnoses. This study reiterates the importance of expert review for many, if not all, lymphoma samples, particularly any T-cell lymphoma and non—follicular small B-cell lymphoma.
Given the complexity of lymphoma classification, it is not surprising that expert hematopathologists can refine diagnoses. As we progress in understanding the specific pathogenesis of lymphoma subtypes and utility of targeted therapy, it becomes even more critical to make correct diagnoses. This study reiterates the importance of expert review for many, if not all, lymphoma samples, particularly any T-cell lymphoma and non—follicular small B-cell lymphoma.
In patients with newly diagnosed lymphoma and suspected lymphoma, a second pathological review found inaccuracies in the original diagnosis among 17% of more than 42,000 cases, based on data presented at the International Congress on Malignant Lymphoma in Lugano, Switzerland.
In more than 25% of all discrepancies, tumors were reclassified at the second pathology review as the result of findings from additional immunostaining and molecular studies – polymerase chain reaction and fluorescence in situ hybridization.
In 15% of cases, diagnostic changes were expected to result in a change in patient management.
“Our study highlights the importance of specialized centralized review of lymphoma diagnosis, not only in the setting of clinical trials but also in routine clinical practice, for optimal patient management,” reported Dr. Camille Laurent of the Institut Universitaire du Cancer Oncopole, Toulouse, France.
In 2010, the French National Cancer Agency (INCa) established the Lymphopath Network, comprising 33 reference centers, to provide a review by expert hematopathologists of every newly diagnosed lymphoma or suspected lymphoma prior to treatment. These new diagnoses were entered in a central national database. Between 2010 and 2015, 42,146 samples were reviewed: 35,753 were newly diagnosed as lymphomas, while the remaining 6,393 cases included 4,610 reactive lymphoid conditions and 1,783 nonlymphoid malignancies, including especially myeloma and leukemic disorders.
Discordant diagnoses among extra-cutaneous lymphomas were carefully examined by a hematologist and recorded as major or minor depending on the expected therapeutic impact. Dr. Laurent said.
The discordance rate between the referral diagnosis and the final diagnosis was 17.2%. Small B-cell lymphomas and peripheral T-cell lymphoma subtyping were the most common discrepancies; 6.4% of discordances were due to an unspecified lymphoma diagnosis, Dr. Laurent stated.
Less than 2% of discrepancies were due to misclassifications of benign versus malignant lymphoid conditions and of Hodgkin lymphoma versus non-Hodgkin lymphoma. There were minor discrepancies (2.2%) in follicular lymphoma misgrading and diffuse large B-cell lymphoma subtypes.
In patients with newly diagnosed lymphoma and suspected lymphoma, a second pathological review found inaccuracies in the original diagnosis among 17% of more than 42,000 cases, based on data presented at the International Congress on Malignant Lymphoma in Lugano, Switzerland.
In more than 25% of all discrepancies, tumors were reclassified at the second pathology review as the result of findings from additional immunostaining and molecular studies – polymerase chain reaction and fluorescence in situ hybridization.
In 15% of cases, diagnostic changes were expected to result in a change in patient management.
“Our study highlights the importance of specialized centralized review of lymphoma diagnosis, not only in the setting of clinical trials but also in routine clinical practice, for optimal patient management,” reported Dr. Camille Laurent of the Institut Universitaire du Cancer Oncopole, Toulouse, France.
In 2010, the French National Cancer Agency (INCa) established the Lymphopath Network, comprising 33 reference centers, to provide a review by expert hematopathologists of every newly diagnosed lymphoma or suspected lymphoma prior to treatment. These new diagnoses were entered in a central national database. Between 2010 and 2015, 42,146 samples were reviewed: 35,753 were newly diagnosed as lymphomas, while the remaining 6,393 cases included 4,610 reactive lymphoid conditions and 1,783 nonlymphoid malignancies, including especially myeloma and leukemic disorders.
Discordant diagnoses among extra-cutaneous lymphomas were carefully examined by a hematologist and recorded as major or minor depending on the expected therapeutic impact. Dr. Laurent said.
The discordance rate between the referral diagnosis and the final diagnosis was 17.2%. Small B-cell lymphomas and peripheral T-cell lymphoma subtyping were the most common discrepancies; 6.4% of discordances were due to an unspecified lymphoma diagnosis, Dr. Laurent stated.
Less than 2% of discrepancies were due to misclassifications of benign versus malignant lymphoid conditions and of Hodgkin lymphoma versus non-Hodgkin lymphoma. There were minor discrepancies (2.2%) in follicular lymphoma misgrading and diffuse large B-cell lymphoma subtypes.
FROM 13-ICML
Key clinical point: A second pathological review of newly-diagnosed lymphoma or suspected lymphoma found discrepancies in 17% of cases.
Major finding: Small B-cell lymphomas and peripheral T-cell lymphoma subtyping were the most common discrepancies; 6.4% of discordances were due to an unspecified lymphoma diagnosis.
Data source: 42,146 samples from the French National Cancer Agency’s Lymphopath Network, comprising 33 reference centers.
Disclosures: Dr. Laurent had no relevant financial disclosures.
Dramatic increase in teen use of e-cigs, hookahs
The use of e-cigarettes and hookahs by middle- and high-school students surged between 2011 and 2014, according to the Centers for Disease Control and Prevention.
In 2014, an estimated 4.6 million middle- and high-school students used a tobacco product. Of those, 2.4 million reported using e-cigarettes and 1.6 million reported using hookahs. The largest increase in these products took place between 2013 and 2014, when use of e-cigarettes tripled and use of hookahs almost doubled.
This is “a very alarming finding,” Dr. Tom Frieden, CDC director, said during a press conference. He noted that the increased use of these products has led to an “uptick in the total number of our children who are using tobacco products” for the “first time in a generation.”
The study, based on data from the 2011-2014 National Youth Tobacco Surveys, found that in the 3-year period between 2011 and 2014, e-cigarette use increased from 1.5% to 13%, and hookah use increased from 4% to 9%. By contrast, there were significant decreases between 2011 and 2014 in use of cigarettes (16% to 9%), cigars (12% to 8%), tobacco pipes (4% to 1.5%), bidis (2.0% to 0.9%), and snus (3% to 2%) (MMWR 2015;64:381-5).
Dr. Frieden emphasized that there is no causal relationship between decreased use of conventional cigarettes and increased use of e-cigarettes and hookahs. Drawing on trends in the adult population, he noted that despite initial hopes that use of e-cigarettes might contribute to reduction in use of combustible cigarettes, this has not been the case and many smokers continue to use both e-cigarettes and combustible cigarettes.
“We reject the notion that we protect kids from cigarettes by allowing them to use e-cigarettes,” said Brian King, Ph.D., deputy director in the CDC Office on Smoking and Health. Any tobacco product is unsafe, “irrespective of whether it’s combustible or noncombustible or electronic.”
“It is important for parents and kids to understand that nicotine is dangerous to kids at any age, whether it’s an e-cigarette, hookah, cigar, or cigarette,” Dr. Frieden emphasized. He urged the establishment of “comprehensive programs,” similar to those used to educate the public about the dangers of conventional cigarettes.
The use of e-cigarettes and hookahs by middle- and high-school students surged between 2011 and 2014, according to the Centers for Disease Control and Prevention.
In 2014, an estimated 4.6 million middle- and high-school students used a tobacco product. Of those, 2.4 million reported using e-cigarettes and 1.6 million reported using hookahs. The largest increase in these products took place between 2013 and 2014, when use of e-cigarettes tripled and use of hookahs almost doubled.
This is “a very alarming finding,” Dr. Tom Frieden, CDC director, said during a press conference. He noted that the increased use of these products has led to an “uptick in the total number of our children who are using tobacco products” for the “first time in a generation.”
The study, based on data from the 2011-2014 National Youth Tobacco Surveys, found that in the 3-year period between 2011 and 2014, e-cigarette use increased from 1.5% to 13%, and hookah use increased from 4% to 9%. By contrast, there were significant decreases between 2011 and 2014 in use of cigarettes (16% to 9%), cigars (12% to 8%), tobacco pipes (4% to 1.5%), bidis (2.0% to 0.9%), and snus (3% to 2%) (MMWR 2015;64:381-5).
Dr. Frieden emphasized that there is no causal relationship between decreased use of conventional cigarettes and increased use of e-cigarettes and hookahs. Drawing on trends in the adult population, he noted that despite initial hopes that use of e-cigarettes might contribute to reduction in use of combustible cigarettes, this has not been the case and many smokers continue to use both e-cigarettes and combustible cigarettes.
“We reject the notion that we protect kids from cigarettes by allowing them to use e-cigarettes,” said Brian King, Ph.D., deputy director in the CDC Office on Smoking and Health. Any tobacco product is unsafe, “irrespective of whether it’s combustible or noncombustible or electronic.”
“It is important for parents and kids to understand that nicotine is dangerous to kids at any age, whether it’s an e-cigarette, hookah, cigar, or cigarette,” Dr. Frieden emphasized. He urged the establishment of “comprehensive programs,” similar to those used to educate the public about the dangers of conventional cigarettes.
The use of e-cigarettes and hookahs by middle- and high-school students surged between 2011 and 2014, according to the Centers for Disease Control and Prevention.
In 2014, an estimated 4.6 million middle- and high-school students used a tobacco product. Of those, 2.4 million reported using e-cigarettes and 1.6 million reported using hookahs. The largest increase in these products took place between 2013 and 2014, when use of e-cigarettes tripled and use of hookahs almost doubled.
This is “a very alarming finding,” Dr. Tom Frieden, CDC director, said during a press conference. He noted that the increased use of these products has led to an “uptick in the total number of our children who are using tobacco products” for the “first time in a generation.”
The study, based on data from the 2011-2014 National Youth Tobacco Surveys, found that in the 3-year period between 2011 and 2014, e-cigarette use increased from 1.5% to 13%, and hookah use increased from 4% to 9%. By contrast, there were significant decreases between 2011 and 2014 in use of cigarettes (16% to 9%), cigars (12% to 8%), tobacco pipes (4% to 1.5%), bidis (2.0% to 0.9%), and snus (3% to 2%) (MMWR 2015;64:381-5).
Dr. Frieden emphasized that there is no causal relationship between decreased use of conventional cigarettes and increased use of e-cigarettes and hookahs. Drawing on trends in the adult population, he noted that despite initial hopes that use of e-cigarettes might contribute to reduction in use of combustible cigarettes, this has not been the case and many smokers continue to use both e-cigarettes and combustible cigarettes.
“We reject the notion that we protect kids from cigarettes by allowing them to use e-cigarettes,” said Brian King, Ph.D., deputy director in the CDC Office on Smoking and Health. Any tobacco product is unsafe, “irrespective of whether it’s combustible or noncombustible or electronic.”
“It is important for parents and kids to understand that nicotine is dangerous to kids at any age, whether it’s an e-cigarette, hookah, cigar, or cigarette,” Dr. Frieden emphasized. He urged the establishment of “comprehensive programs,” similar to those used to educate the public about the dangers of conventional cigarettes.
